SW4220602_Supplement-EZ Form_20220713

SUPPLEMENT-EZ COVER PAGE
FORMS LOADED
PROJECT INFORMATION
1
Project Name
2
Project Area (ac)
3
Coastal Wetland Area (ac)
4
Surface Water Area (ac)
5
Is this project High or Low Density?
6
Does this project use an off -site SCM?
Nordfab Systems, Inc. Buidli
15.06
1.14
Low
No
ion
COMPLIANCE WITH 02H .1003(4)
7
Width of vegetated setbacks provided (feet)
30
8
Will the vegetated setback remain vegetated?
Yes
9
If BUA is proposed in the setback, does it meet NCAC 02H.1003(4)(c-d)?
N/A
10
Is streambank stabilization proposed on this project?
No
NUMBER AND TYPE OF SCMs:
11
Infiltration System
0
12
Bioretention Cell
0
13
Wet Pond
0
14
Stormwater Wetland
0
15
Permeable Pavement
0
16
ISand Filter
0
17
Rainwater Harvesting (RWH)
0
18
Green Roof
0
19
Level Spreader -Filter Strip (LS-FS)
0
20
Disconnected Impervious Surface (DIS)
0
21
Treatment Swale
0
22
1 Dry Pond
0
23
StormFilter
0
24
Silva Cell
0
25
Bayfilter
0
26
Filterra
0
FORMS LOADED
DESIGNER CERTIFICATION
27
Name and Title:
Benjamin A. Palmer, PE / Project Engineer
28
Organization:
Davis -Martin -Powell
29
Street address:
6415 Old Plank Road
30
City, State, Zip:
High Point, NC 27265
31
Phone number(s):
336-886-4821
32
1 Email:
[e-mail]
Certification Statement:
I certify, under penalty of law that this Supplement-EZ form and all supporting information were prepared under my direction or supervision, that
the information provided in the form is, to the best of my knowledge and belief, true, accurate, and complete, and that the engineering plans,
specifications, operation and maintenance agreements and other supporting information are consistent with the information provided here.
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......... R0
SEAL
25496
06/18/2022
F/VGI NEVR
Signature of Designer
Seal
Date